OBJECTIVE: Decompressive hemicraniectomy (DH) has been shown to reduce mortality in patients with malignant middle cerebral artery (MCA) territory infarction. However, many patients survive with moderate-to-severe disability and controversy exists as to whether this should be considered good outcome. To answer this question, we assessed the quality of life (QoL) of patients after DH for malignant MCA territory infarction in our milieu. METHODS: The outcome of all patients undergoing DH for malignant MCAterritory infarction between 2001 and 2009 was assessed using retrospective chart analysis and telephone follow-up in survivors. Functional outcome was determined using Glasgow outcome scale, modifed Rankin scale (mRS), and Barthel index (BI). The stroke impact scale was used to assess QoL. RESULTS: There were 14 patients, 6 men and 8 women, with a mean age of 44 years (range 27-57). All patients had reduced level of consciousness preoperatively. Five had dominant-hemisphere stroke. Median time to surgery was 45 hours (range 1- 96). Two patients died and one was lost to follow-up. Of 11 survivors, 7 (63.6%) had a favorable functional outcome (mRS<4). No patient was in persistent vegetative state. Despite impaired QoL, particularly in physical domains, the majority of interviewed patients and caregivers (7 of 8), including those with dominant-hemisphere stroke, were satisfied after a median follow-up of 18 months (range 6-43). CONCLUSION: Most patients report satisfactory QoL despite significant disability even in the face of moderate-to-severe disability and dominant-hemsiphere stroke. Dominant-hemisphere malignant MCA territory infarction should not be considered a contraindication to DH.
OBJECTIVE: Decompressive hemicraniectomy (DH) has been shown to reduce mortality in patients with malignant middle cerebral artery (MCA) territory infarction. However, many patients survive with moderate-to-severe disability and controversy exists as to whether this should be considered good outcome. To answer this question, we assessed the quality of life (QoL) of patients after DH for malignant MCA territory infarction in our milieu. METHODS: The outcome of all patients undergoing DH for malignant MCAterritory infarction between 2001 and 2009 was assessed using retrospective chart analysis and telephone follow-up in survivors. Functional outcome was determined using Glasgow outcome scale, modifed Rankin scale (mRS), and Barthel index (BI). The stroke impact scale was used to assess QoL. RESULTS: There were 14 patients, 6 men and 8 women, with a mean age of 44 years (range 27-57). All patients had reduced level of consciousness preoperatively. Five had dominant-hemisphere stroke. Median time to surgery was 45 hours (range 1- 96). Two patients died and one was lost to follow-up. Of 11 survivors, 7 (63.6%) had a favorable functional outcome (mRS<4). No patient was in persistent vegetative state. Despite impaired QoL, particularly in physical domains, the majority of interviewed patients and caregivers (7 of 8), including those with dominant-hemisphere stroke, were satisfied after a median follow-up of 18 months (range 6-43). CONCLUSION: Most patients report satisfactory QoL despite significant disability even in the face of moderate-to-severe disability and dominant-hemsiphere stroke. Dominant-hemisphere malignant MCA territory infarction should not be considered a contraindication to DH.
Authors: Jennifer A Frontera; J Randall Curtis; Judith E Nelson; Margaret Campbell; Michelle Gabriel; Anne C Mosenthal; Colleen Mulkerin; Kathleen A Puntillo; Daniel E Ray; Rick Bassett; Renee D Boss; Dana R Lustbader; Karen J Brasel; Stefanie P Weiss; David E Weissman Journal: Crit Care Med Date: 2015-09 Impact factor: 7.598
Authors: Michel T Torbey; Julian Bösel; Denise H Rhoney; Fred Rincon; Dimitre Staykov; Arun P Amar; Panayiotis N Varelas; Eric Jüttler; DaiWai Olson; Hagen B Huttner; Klaus Zweckberger; Kevin N Sheth; Christian Dohmen; Ansgar M Brambrink; Stephan A Mayer; Osama O Zaidat; Werner Hacke; Stefan Schwab Journal: Neurocrit Care Date: 2015-02 Impact factor: 3.210
Authors: Hermann Neugebauer; Claire J Creutzfeldt; J Claude Hemphill; Peter U Heuschmann; Eric Jüttler Journal: Neurocrit Care Date: 2014-08 Impact factor: 3.210
Authors: Ralph Rahme; Lincoln Jimenez; Umair Bashir; Opeolu M Adeoye; Todd A Abruzzo; Andrew J Ringer; Brett M Kissela; Jane Khoury; Charles J Moomaw; Heidi Sucharew; Simona Ferioli; Matthew L Flaherty; Daniel Woo; Pooja Khatri; Kathleen Alwell; Dawn Kleindorfer Journal: Childs Nerv Syst Date: 2012-08-23 Impact factor: 1.475